Transcript PPTX Workflow Redesign Templates Presentation

Workflow Redesign Templates
Provided By:
The National Learning Consortium (NLC)
Developed By:
Health Information Technology Research Center (HITRC)
Practice and Workflow Redesign Community of Practice
10/21/11 • Version 1.0
National Learning Consortium
•
The National Learning Consortium (NLC) is a virtual and evolving body of
knowledge and tools designed to support healthcare providers and health
IT professionals working towards the implementation, adoption and
meaningful use of certified EHR systems.
•
The NLC represents the collective EHR implementation experiences and
knowledge gained directly from the field of ONC’s outreach programs
(REC, Beacon, State HIE) and through the Health Information Technology
Research Center (HITRC) Communities of Practice (CoPs).
•
The following resource is a tool used in the field today and recommended
by “boots-on-the-ground” professionals for use by others who have made
the commitment to implement or upgrade to certified EHR systems.
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Template Instructions:
Mapping an Existing Workflow
•
To use these templates, first identify the current type of workflow you want
to redesign, and then identify the staff responsible for the activities in the
workflow.
•
In collaboration with the implementation team, they should review the
workflow and adjust it as necessary to match the typical scenario in their
office.
•
Assign a note taker/recorder to enter the steps into the boxes and arrows on
the PowerPoint slide. The note taker/recorder can move the PowerPoint
boxes and arrows to reflect how the staff order the interactions.
•
In the workflow templates, boxes indicate steps in the process. Blue
diamonds indicate “yes or no” decision points and lead to appropriate next
steps depending on the “yes or no” decision. Staff can indicate decision
point steps by turning a sticky note sideways 45 degrees or by drawing a
diamond on the box.
Note: Double-click workflow diagrams to make edits
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Template Instructions :
Examining Areas for Improvement
•
After mapping existing workflows, the staff should ask themselves the
following questions:
– What are the best steps in the process?
– What makes those the best steps?
– What are we doing right? (Best can be defined by practice goals and
vision, such as efficiency, client satisfying, etc.)
– What steps could use improvement?
– What are the least effective?
– What makes those steps the least effective?
– How could we improve those steps?
•
Use the answers to these questions to aid in planning a future workflow
with the new EHR
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Key Steps to Optimize Workflow
Redesign
•
Analyze current workflow
– Document the practice’s existing paper workflows in all areas of patient care
•
Solicit clinician and staff input regarding roles in current paper
workflows
– Involve everyone who handles paperwork in the analysis and redesign
•
Review and finalize documentation of current workflow
– Ensure that the final diagram incorporates the entire “paper trail”
•
Identify waste and opportunities; then redesign workflow
– Recognizing the steps that should be changed to improve office functionality; the
redesign will reveal the practice’s needs regarding EHR system selection and training
•
Identify and implement the EHR system and new workflow
– Enlist the necessary support and work with the right EHR vendor to implement a
system that meets the practice’s needs; ensure proper EHR implementation through
staff training on the new workflow
•
Analyze new EHR workflow and refine as needed
– Continue to monitor the EHR-driven workflow and adjust the workflow to optimize
efficiencies
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Patient Check-In
•
SUMMARY OF MODULE/SECTION: This section will help practice staff
map out the patient check-in process; it provides several different
templates that can describe the existing check-in process and the
check-in process that might be achieved with an EHR. These
interactive templates focus on what happens once the patient enters
the office until the patient meets with the physician or nursing staff.
Templates included in this section include the following:
– Paper Process: The paper check-in template describes an office setting that
relies solely on paper charts for patient documentation. This template will be
useful for outlining the workflow of offices that currently do not have an EHR.
– EHR without Integration/Interface with Practice Management System (PMS):
This template provides a draft workflow for an office with a non-integrated EHR.
This template will be useful for offices that require front desk staff to enter patient
documentation separately into the PMS and EHR.
– EHR is Fully Integrated/Interfaced with Practice Management System (PMS):
This template outlines the check-in process for a practice that uses a single
system for its check-in process and does not have separate EHR and PMS
systems for managing patients. This template may be more useful when
mapping out how the desired patient check-in process after implementing the
EHR.
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Patient Check-In, continued
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RATIONALE/PURPOSE OF THE SECTION: The front desk/reception
staff play a critical role in the practice: they serve as the welcoming face
of the practice, gather important patient history and updates and
manage payment collection. They do all of these things during the
check-in process. Before transitioning to a fully integrated EHR checkin process, mapping out the existing paper check-in or non-integrated
EHR check-in process will help the front desk/reception staff to identify
current workflows could be adapted to accommodate the forthcoming
EHR.
•
MEANINGFUL USE OBJECTIVES:
– Use of the paper process does not meet any of the meaningful use
requirements. Use of a non-integrated EHR or an integrated EHR
satisfies the meaningful use requirement: Core 7 - record patient
demographics as structured data.
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Patient Check-In Paper Process
Patient
Pa ti ent Check-in Paper Process
Patient
Arrives
Signs in at
Front Desk
Marks Patient
Arrival
Patient Completes
Forms
Yes
New
Patient?
Give Pt. Forms to
fill out, collect &
copy insurance
card
No
Collect and file
forms in newly
created chart
Front Desk Receptionist
Pull Paper Chart
(from staging
area)
Does Pt
Info need
to be
updated?
Yes
Yes
Record updates in
paper chart,
collect & copy
insurance card if
needed
No
Collect Payment &
generate record of
payment for billing
department
Yes
Note: Double-click
workflow diagram
to make edits
Does copay need
to be
collected?
No
Generate
Flowsheet
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Put chart & flowsheet in
bin indicating patient is
ready for rooming
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Patient Check-In Process:
EHR without Integration/Interface with
Practice Management System (PMS)
Patient
Patient Check-in Process – EHR without Integration/Interface with Practice
Management System (PMS)
Patient
Arrives
Patient
Completes
Forms
Signs in at
Front Desk
Marks Patient
Arrival into
PMS and/or
EHR
New
Patient?
Yes
Give Pt. Forms to
fill out, collect &
copy or scan
insurance card
Collect and enter
information into
PMS and/or EHR
No
Front Desk Receptionist
No
Select Patient
from PMS
and/or EHR
Does Pt
Info need
to be
updated?
Yes
Record updates in
PMS and/or EHR,
collect & copy
insurance card if
needed
MU Objective:
Record Pt
Demographics as
Structured Data
No
Collect
Payment &
record into
PMS
Yes
Note: Double-click
workflow diagram
to make edits
Does copay need
to be
collected?
No
Mark “pt is ready” for
rooming into PMS and/or
EHR
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Patient Check-In Process:
EHR is Fully Integrated/Interfaced with
Practice Management System (PMS)
Patient
Patient Check-in Process – EHR is Fully Integrated/Interfaced with Practice
Management System (PMS)
Patient
Arrives
Signs in at
Front Desk
Marks
Patient
Arrival on
EHR
Patient Completes
Forms
Yes
New
Patient?
Give Pt. Forms to
fill out, collect &
scan insurance
card
No
Collect and enter
information in
EHR
Front Desk Receptionist
Select Patient
from EHR
Does Pt
Info need
to be
updated?
No
Collect
Payment &
record into
EHR
Yes
Yes
Yes
Record
EHR,
scan
card
updates in
collect &
insurance
if needed
MU Objective:
Record Pt
Demographics as
Structured Data
Note: Double-click
workflow diagram
to make edits
Does copay need
to be
collected?
No
Mark “pt is ready” for
rooming into EHR
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Office Visit
•
SUMMARY OF MODULE/SECTION: This section covers the office visit
workflow. It should help you and your practice staff detail what happens
when a patient enters your practice for an appointment and what should
happen once the EHR is implemented. This interactive template
contains:
– Patient arrival at the office and checks in through the encounter close
out in the EHR;
– How nursing, support and provider staff roles interacts with the patient
and EHR;
– Measurement and entry of vital signs, medication updates, and patient
complaints;
– Patient examination; and,
– How the EHR supports decision making and prescribing (see ePrescribing section for more information and instructions on mapping ePrescribing workflows).
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Office Visit, continued
•
RATIONALE/PURPOSE OF THE SECTION: As office visits are the
primary activity of most practices, It is essential to navigating the patient as
efficiently as possible through a typical office visit. Research has shown that
an EHR can increase patient volume between 2 and 15% (Keshajvee 2001;
MedicaLogic), In addition, the data collected will enable time savings
associated with quality reporting as well as conduct population health
activities. Integrating an EHR into that office visit can also improve the
quality of care and patient safety by offering electronic triggers to remind
staff about patient considerations (e.g., allergies, pre-existing conditions)
and to prevent drug interactions (see e-Prescribing workflows for more
details).
•
MEANINGFUL USE OBJECTIVES:
–
–
–
–
–
–
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Core 3 - maintain an up-to-date problem list of current and active diagnosis
Core 5 - Maintain active medication list
Core 6 - Maintain active medication allergy list
Core 8 - Record and chart changes in vital signs
Core 9 - Record smoking status for patients 13 yrs or older
Core 11- Implement one CDS rule
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Office Visit Workflow Template
Patient
Offi ce Vi s it Workfl ow Template
Arrives &
checks in
Greets patient
and escorts to
clinic area
Obtains
patient’s
weight, height,
blood pressure,
temp., etc.
Nurse/Support
Views EHR
schedule &
patient “arrived”
status
Escorts
patient to
exam room
& logs into
EHR
Select & open
patient’s
electronic
record
Enters vitals
& chief
complaint
MU Objective:
Record and chart
changes in vital
signs
Secures
workstation
and leaves
room
Record history:
past medical,
social, family,
substance
(smoking
history), etc.
Verify &
record
allergies &
current
medications
MU Objective:
Maintain active
medication &
medication allergy list
MU Objective:
Record smoking status
for patients 13 years old
or older
Provider
Performs chart
review before
entering exam
room
Closes the
encounter in
EHR
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Enters the
room, greets
patient, and
logs onto
workstation
Consults with
patient and
records HPI
Performs
physical
exam
Documents
review of
systems &
physical exam
into EHR
Provides
patient with
instructions/
materials
Assigns
Level of
Service
(LOS)
Places
orders as
necessary
(see Orders
workflow)
Note: Double-click
workflow diagram
to make edits
Updates problem list
& triggers CDS rules
if needed
MU Objective:
Maintain problem list
of current and active
diagnoses &
implement relevant
CDS rules
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e-Prescribing
•
SUMMARY OF MODULE/SECTION: This section will help practice staff
map out the e-prescribing workflow, both during an office visit and out of
an office visit for renewal requests These interactive templates focus
on what steps need to be taken to:
– Populate an EHR with the current medications and existing medication
allergies for the patient;
– Enter an order in the EHR, including updating medication history,
checking drug formulary data (if enabled), and selecting the medication;
– Transmit the prescription order to the pharmacy, which may be manual
(by the patient), fax/e-fax, or electronically (e.g., through the ePrescribing networks available);
– Process the prescription at the pharmacy; and,
– Pick up by the patient
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e-Prescribing, continued
•
RATIONALE/PURPOSE OF THE SECTION: E-prescribing represents an
opportunity to greatly streamline practices in the office. Research has shown that
there are significant time savings from processing prescription renewals, with 80 to
95% reductions in renewal times that average 18 minutes (Corley 2005,
MedicaLogic). It presents an opportunity to remove the chart pulls and office worker
handling of the renewals, sending requests directly to a prescribing provider who can
access the patient’s medical history and select a previously prescribed medicine.
There are also safety benefits that need to be considered, as adverse drug events,
including drug-drug and drug-allergy interactions, can be reduced by 23-34% (Smith
2006, Wang 2003). In addition, drug-formulary checks can help save patients 1520% on their prescription drug costs (Wang 2003, MedicaLogic). It is therefore
important that the person entering the medication order into the e-prescribing system
be able to process any alerts properly or that an alert processing steps are streamline
to mitigate their impact on workflow.
•
MEANINGFUL USE OBJECTIVES:
–
–
–
–
–
–
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Core 1 - Use CPOE for medication orders
Core 2 - Implement drug-drug and drug allergy checks
Core 4 - Generate and transmit permissible prescriptions electronically (eRx)
Core 5 - Maintain active medication list
Core 6 - Maintain active medication allergy list
Menu 1 - Implement drug-formulary checks
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e-Prescribing Workflow Template:
During Office Visit
ePrescribing Workflow Template – During Office Visit
Patient
Interviews patient
for Rx details of
current medications
and allergies
Asks patient
for pharmacy
information
Prescriber sees
patient and
identifies need for
Rx(s)
Reviews and
updates Rx History
& allergy list
Prescriber
Clerk/Tech/
Nurse
Patient drops-off
Rx(s) at
pharmacy or
sends mail order
Patient arrives
MU Objectives:
Maintain active
medication and allergy
lists
MU Objectives:
Implement drug-drug, drugallergy, drug-formulary
checks
Verify patient
pharmacy
information
Print or Fax
Rx(s) &/or
Call-in Rx(s)
No
Select, update,
and order Rx(s)
No
Yes
New
Rx?
Select Rx(s), check
for alerts, & order
Rx(s)
Can Rx(s) be
ePrescribed?
Pharmacy
ePrescribing
Network
Yes
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MU Objective:
Use CPOE
Patient picks
up Rx(s)
Notifies
patient that
Rx(s) filled
& ready for
pick-up
Rx transmitted
Check patients Rx
benefit information
Rx(s) filled
Receives
Rx(s)
MU Objective:
Implement drugformulary checks
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Note: Double-click
workflow diagram
to make edits
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e-Prescribing Workflow Template:
Medication Refill
Patient
Patient
requests
refill
Clerk/Tech/
Nurse
ePrescribing Workflow Template – Medication Refill
Interviews patient
for RX details of
current medications
and allergies
Asks patient for
pharmacy
information &
sends request to
prescriber
Receives Rx refill
request
Reviews and
updates Rx History
& allergy list
Patient drops-off Rx(s)
at pharmacy or sends
mail order
MU Objectives:
Maintain active medication
and allergy lists
MU Objectives:
Implement drug-drug, drugallergy, drug-formulary checks
Verify patient
pharmacy
information
Print or Fax
Rx(s) &/or
Call-in Rx(s)
Prescriber
No
Select, update,
and order Rx(s)
No
New
Rx?
Yes
Select new
Rx(s), check
for alerts, &
order Rx(s)
Can Rx(s) be
ePrescribed?
Pharmacy
ePrescribing
Network
Yes
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MU Objective:
Use CPOE
Pharmacy
transmits Rx
refill request
Patient picks up Rx(s)
Rx
transmitted
Check patients Rx
benefit information
Notifies patient
that Rx(s) filled
& ready for
pick-up
Rx(s) filled
MU Objective:
Implement drugformulary checks
Note: Double-click
workflow diagram
to make edits
Receives Rx(s)
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Appointment Scheduling
•
SUMMARY OF MODULE/SECTION: This section will help practice staff
map out the appointment scheduling process during an office visit. This
section covers:
–
–
–
–
–
Finding the patient in the EHR;
Creating a new patient record (if applicable);
Selecting a reason for an appointment;
Finding a time for the appointment; and,
Finalizing with the patient.
•
RATIONALE/PURPOSE OF THE SECTION: Appointment scheduling is
likely to vary depending on the communication method (i.e., phone call,
post-visit, or email). In addition, interfacing between the practice
management system and the EHR will vary depending on the vendor
products installed at the practice. It is important to ensure a proper process
is in place to sync these two systems.
•
MEANINGFUL USE OBJECTIVES:
– There are none that apply with the current stage of Meaningful Use
criteria
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Appointment Scheduling Workflow
Template
Clerk or
Provider
Appointment Scheduling Workflow Template
Patient needs
appointment
New
Patient?
No
Search for patient
in system (MRN,
Name, DOB, etc.)
Select provider
and Open
appointment
schedule
Select Reason or
Type of
Appointment
Scheduler
Yes
Create new record
in system
Appointment
Scheduled
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Search for specific
date or next
available
appointment
Enter patient
information
Summarize
appointment
verbally or give
appointment card
Select
appointment
slot(s) and save
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Note: Double-click
workflow diagram
to make edits
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Laboratory Orders
•
SUMMARY OF MODULE/SECTION: This section will help practice staff
map out the laboratory ordering process during an office visit. This
section covers three different workflows:
– Laboratory Ordering in the Office: This workflow focuses on what
happens to laboratory tests under two different scenarios: 1) the
laboratory test is conducted during the office visit; or 2) the patient
leaves the office visit with a laboratory test order.
– Laboratory Results: This workflow captures handling of the laboratory
results receipt and entry into the EHR.
– Laboratory Orders and Results Management: This workflow focuses
on what happens to the results of laboratory orders under three different
scenarios: 1) the office staff generate a list of orders; 2) the patient calls
the office for results; or 3) the provider receives the results from the
laboratory.
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Laboratory Orders, continued
•
RATIONALE/PURPOSE OF THE SECTION: Laboratory tests are critical component
of patient care. Office staff are responsible for ensuring that both the test and the
results are completed communicated to the patient and the provider in a timely
fashion. Before transitioning to an EHR with electronic laboratory ordering features,
mapping out the existing workflow for ordering laboratory tests and tracking the
results will help the office staff to identify how the workflow needs to be adapted to
accommodate the forthcoming EHR. The office staff responsible for laboratory orders,
in collaboration with the implementation team, should imagine each of the steps
involved in ordering laboratory tests, tracking their status, and obtaining the results
and communicating those results to the patient and provider. An EHR can improve
the efficiency and timeliness of laboratory orders by eliminating paper documentation,
integrating an current freestanding database with the EHR, or simply eliminating
redundancies. Research has shown that between 4 and 23% of lab costs are for
redundant testing (Wang 2003, Girosi 2005, Garrido 2005), the majority of which
could be avoided by recording the results electronically and sharing that data with
other providers.
•
MEANINGFUL USE OBJECTIVES:
– Core 11 - Implement one CDS rule
– Menu 2 - Incorporate clinical lab-test results into EHR as structured data
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Laboratory Order Workflow Template:
During Office Visit
Laboratory Order Workflow Template – During Office Visit
Patient leaves
No labs needed
Specimen
collected?
Patient leaves
with lab order
Patient
Patient Arrives
No
No
Test
needed?
Yes
Order test with
appropriate
diagnosis code(s)
MU Objectives:
-- Implement CDS Rule
Provider
Office Visit
Yes
No
Point of
Care Test?
Note: Double-click
workflow diagram
to make edits
Laboratory
Yes
Test results
generated &
Sent to provider
Test
performed?
No
See Lab
Results
Workflow
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Yes
Notify provider
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Laboratory Results Workflow
Laboratory Results Workflow
MA or Clerk
Lab results received
MU Objective:
Incorporate clinical lab
test results into certified
EHR technology as
structured data
Critical lab
values?
Yes
Alert provider
immediately
No
Notify patient of
lab results
Patient
Provider
Route results to
ordering provider
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Provider receives
lab results
Provider takes
action, if
necessary
MU Objectives:
-- Provide patient with electronic
copy of their test results upon
request
-- Provide patients with timely
electronic access to their lab
results
Provider signs off
on lab results
Note: Double-click
workflow diagram
to make edits
Patient receives
notification of lab
results
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Lab Orders and Results Management
Lab Orders and Results Management
Generate list of
pending orders
Provider
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Send reminder
or follow-up
with patient
Test
Performed
No
Yes
Search for patient
and lab results in
EHR
Lab results
available?
Yes
Send
message to
provider
Patient receives
notification:
reminder or lab
results
Patient calls for lab results
Laboratory
Patient
Nurse, MA or Clerk
No
MU Objectives:
-- Provide patient with electronic
copy of their test results upon
request
-- Provide patients with timely
electronic access to their lab
results
Test results
generated
and sent to
provider
MU Objective:
Incorporate clinical
lab test results into
certified EHR
technology as
structured data
Provider
receives lab
results
Provider
signs off on
lab results
Note: Double-click
workflow diagram
to make edits
Notify
patient of
lab results,
if needed
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Referral Generation
•
SUMMARY OF MODULE/SECTION: This section will help practice staff
map out the referral generation process. This interactive template
focuses on what steps need to be taken to:
– Generate a referral request by the provider;
– Create the referral order, including insurance checks and generation of
necessary data from EHR;
– Send the referral order to the referred provider;
– Visit with the referred physician and patients; and,
– Communicate results from the referred to the referring provider.
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Referral Generation, continued
•
RATIONALE/PURPOSE OF THE SECTION: A major source of health care
fragmentation, duplication and miscommunication is in the transition of care
from one provider to another or the co-management of patient care among two
or more providers. Office staff are responsible for ensuring that referrals are
generated to both the patient and the specialist and that the status outcomes of
those referrals or transitions are closely monitored and documented. Before
transitioning to an EHR with electronic laboratory ordering features, mapping out
the existing workflow for transitions and will help the office staff to identify how
the workflow needs to be adapted to accommodate the forthcoming EHR. Staff
should identify how and where an EHR can improve the tracking and
documentation of referrals by streamlining the point of entry, providing prompts
or reminders, and allowing all who need the referral information ready access to
it. Research has shown that EHRs can save up to 210 hours per physician per
year through use of electronic referral generation (MedicaLogic).
•
MEANINGFUL USE OBJECTIVES:
– Menu 8 - Provide a summary of care record for each transition of care or referral
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Referral Generation Workflow Template
Determines patient
needs referral
Generates
referral order
Generates
encounter
documentation
Patient
PCP
Referral Generation Workflow Template
Patient
receives
referral
Specialty Provider Office
MA or Clerk
Receives
referral order
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Receives Summary of
Care document from
specialty provider
MU Objective:
Provide Summary of Care
Record for each transition
of care and referral
Contacts specialty
provider for
appointment
Obtains insurance
authorization, if
needed
Generates referral
Routes specialty
documentation to
PCP
Generate
Summary of Care
Document
Send referral
documentation via
eExchange,
secure email,
faxing, or printing
Receives
message from
specialty provider
Receives referral
documentation
Schedules
appointment
Provides specialty
service(s) to
patient
Generates
encounter
documentation
Note: Double-click
workflow diagram
to make edits
Generate & send
Summary of Care
Document to PCP
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Office Discharge
•
SUMMARY OF MODULE/SECTION: This section will help practice staff
map out the office visit discharge process, including steps that need to
be taken post-visit to ensure the practice meets Stage 1 Meaningful
Use criteria. This interactive template focuses on what steps need to
be taken to:
– Complete visit documentation;
– Provide the patient with all necessary orders and information,
including electronic transmittal depending on the type of order;
– Schedule any follow-up appointments; and,
– Send any public health data to the necessary local, state, and/or
federal agencies.
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Office Discharge, continued
•
RATIONALE/PURPOSE OF THE SECTION: The office visit discharge largely
encompasses those activities that provider patients with any data or orders that
are ready when they are leaving. By the Stage 1 Meaningful Use criteria,
clinical summaries (Core 13) are required within a specified time and are not
necessarily part of the discharge process. Care transition summaries (Menu 8),
which will be required by Stage 2 criteria, do not have a time requirement, and
may be transmitted at any time prior to the patient’s first appointment with the
new provider (likely when the referral order is completed). In addition,
submission of immunization data (Menu 9) or syndromic surveillance data
(Menu 10), which are also to be required by Stage 2, do not require that data be
transmitted at the duration of any appointment, or at any time at all; they are
only required to test this capability to support future requirements in this arena.
It is important to note that majority of activities with this workflow can be
conducted outside of a patient visit, along with other requirements of Stage 1
Meaningful Use. As these are non-value-added activities (i.e., they don’t
generate revenue per se), it is important to understand the time it takes to do
these activities and how these processes can be streamlined with the adoption
of an EHR.
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Office Discharge, continued
•
MEANINGFUL USE OBJECTIVES:
– Core 1 - Use CPOE for medication orders
– Core 4 - Generate and transmit permissible prescriptions electronically
(eRx)
– Core 13 - Provide clinical summaries for each office visit
– Menu 8 - Provide a summary of care record for each transition of care
or referral
– Menu 9 - Capability to submit electronic data to immunization registries
or immunization information systems
– Menu 10 - Capability to submit electronic syndromic surveillance data to
public health agencies
10/21/11 • Version 1.0
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Office Discharge Workflow Template
Nurse, MA, or Clerical Staff
Provider
Patient
Office Discharge Workflow Template
10/21/11 • Version 1.0
Receives orders,
instructions,
follow-up
appointment, etc.
Patient exits
exam room
Completes
encounter
documentation
Patient
exits office
MU Objectives:
-- Use CPOE
-- Generate and transmit
permissible ePrescriptions
Review patient
instructions and
orders
Print or send
orders to
appropriate
recipients
Schedule followup appointment(s),
if needed
Print or send summary of care
document (including instructions,
patient-specific education materials,
and medication list), if needed
Note: Double-click
workflow diagram
to make edits
MU Objectives:
-- Provide clinical summaries
-- Provide summary of care record
for transition of care
Submit data to
Immunization Registry,
Public health agencies,
quality measures to CMS
or States, etc., if needed
MU Objectives:
-- Capability to submit electronic data to immunization registry
-- Capability to submit electronic syndromic surveillance data to
public health agencies
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